Introduction: Standard treatment for acute obstructive hydrocephalus secondary to blood products was a standard external ventricular drainage (EVD) catheter which relies on time and gravity to clear the obstruction. The innovation of active fluid exchange catheters such as (IRRAflow IRRAS AB), allowing intraventricular irrigation along with CSF drainage, and allows infusion of thrombolytics to enhance blood clearance transforming the options for drainage. The systemic implications of continuous irrigation and medication infusion, particularly on systemic inflammatory response syndrome (SIRS), remain unclear. Methods: We retrospectively reviewed 29 patients with nontraumatic intracerebral hemorrhage who received IRRAflow and survived beyond 72 hours.. 25 patients with standard extra ventricular drains with bleeds of similar severity (Hunt & Hess 4 or ICH score of 2-4) were selected. The percentage of days in which the patient met SIRS criteria, while drain was in place was calculated. Subgroup analyses were performed for isolated subarachnoid hemorrhage (SAH), isolated intraventricular hemorrhage (IVH), and intraparenchymal hemorrhage with intraventricular extension (IPH with IVH). Samples were compared using a Mann Whitney U Test at p-values of both 0.01 and 0.05. Statistics were conducted using Microsoft Excel. Results: Across all patients, the IRRAflow group met SIRS criteria on 38.46% (±31.7%) of irrigation days versus 37.97% (±28.1%) in the EVD group (p = 0.9.06). Among patients with SAH, IRRAflow patients met criteria on 45.9% (±33.89%) of days compared to 36.45% (±32.3%) in the EVD group (p = 0.195). In IPH w/ IVH, SIRS criteria were met on 29.34% (±38.49%) of days for IRRAflow vs. 35.84% (±25.6%) for EVD (p = 0.337). No comparisons were statistically significant, though the differences—particularly in the SAH subgroup (9% absolute difference), may be clinically relevant. Conclusions: Overall patients with IRRAflow, particularly in the SAH group had higher rates of SIRS criteria. While not statistically significant, these findings raise questions about the systemic effects of continuous irrigation and the potential for increased antibiotic exposure. Further prospective studies are warranted.
Frost et al. (Sun,) studied this question.